Yim Ga Won, Lee Jiyeon, Yang Kyungmo, Lee Chae Hyeong, Huy Nguyen Vu Quoc, Vo Minh Tuan, Yoon Sangchul
Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Korea.
International Development, Department of International Studies, Graduate School of International Studies, Seoul National University, Seoul, Korea.
Int J Gynaecol Obstet. 2025 Feb;168(2):518-524. doi: 10.1002/ijgo.15867. Epub 2024 Aug 22.
This study assessed the feasibility of smartphone-based colposcopy (SBC) for visual inspection of the cervix by community healthcare workers in low-resource areas.
This was a retrospective study conducted in community villages in rural Vietnam, where 177 participants were enrolled for a cervical cancer screening. Cervical images were obtained by pre-trained community healthcare workers using a portable, upcycled SBC (Samsung Galaxy Note 20). Images were taken before and after the visual inspection after acetic acid (VIA) examination. Captured images were stored on a web server through an Android-based application and later reviewed independently by two experienced gynecologists. Image quality was assessed, and kappa statistics were calculated for the measurement of agreement in VIA findings.
Cervical images of 177 women obtained between July and August 2020 were analyzed. The mean age of women was 42 ± 9.1 years, and 20.3% were postmenopausal. The percentage of adequate visibility of the squamocolumnar junction (SCJ) in the captured images was 83.1%. The kappa value for interobserver reliability was 0.61 for VIA positivity agreement between the two gynecologists. Image clarity was rated as average or above in 77.3%. The reasons for suboptimal clarity were poor focusing (15.3%), inadequate SCJ visibility (18%), and obscuring of the transformation zone due to blood (11.3%), discharge (14.7%), or artifacts such as intrauterine devices or polyps (5.1%).
Upcycled SBC was feasible when performed by pre-trained healthcare workers in a low-resource setting. VIA findings by SBC showed adequate agreement between two independent assessments, suggesting its potential as a method to aid cervical cancer screening.
本研究评估了在资源匮乏地区，由社区医护人员使用基于智能手机的阴道镜检查（SBC）对宫颈进行目视检查的可行性。
这是一项在越南农村社区村庄开展的回顾性研究，177名参与者纳入宫颈癌筛查。经预培训的社区医护人员使用便携式、升级改造后的SBC（三星Galaxy Note 20）获取宫颈图像。在醋酸肉眼观察法（VIA）检查前后拍摄图像。捕获的图像通过基于安卓的应用程序存储在网络服务器上，随后由两名经验丰富的妇科医生独立进行复查。评估图像质量，并计算kappa统计量以衡量VIA检查结果的一致性。
分析了2020年7月至8月期间获得的177名女性的宫颈图像。女性的平均年龄为42±9.1岁，20.3%为绝经后女性。捕获图像中鳞柱交界（SCJ）可见度充足的百分比为83.1%。两位妇科医生之间VIA阳性一致性的观察者间可靠性kappa值为0.61。77.3%的图像清晰度被评为中等或以上。清晰度欠佳的原因包括对焦不佳（15.3%）、SCJ可见度不足（18%）以及血液（11.3%）、分泌物（14.7%）或宫内节育器或息肉等伪像（5.1%）导致转化区模糊。
在资源匮乏环境中，由经过预培训的医护人员进行升级改造后的SBC是可行的。SBC的VIA检查结果在两项独立评估之间显示出充分的一致性，表明其作为辅助宫颈癌筛查方法的潜力。
